Cancer Facts & Figures for African Americans
2011-2012
Contents Cancer Statistics
1
Selected Cancers
8
Risk Factor Statistics
14
Use of Screening Tests
18
How the American Cancer Society Helps Save Lives and Helps Reduce Cancer Disparities
19
What Other Programs/Organizations Support the Elimination of Health Disparities among African Americans?
22
Sources of Statistics
24
Screening Guidelines for the Early Detection of Cancer in Average-risk Asymptomatic People
25
References
26
Acknowledgments The production of this report would not have been possible without the efforts of: Priti Bandi, MS; Linda Blount, MPH; Otis Brawley, MD; Durado Brooks, MD, MPH; Sheila Buchert; Carolina Casares, MD, MPH; Vilma Cokkinides, PhD, MSPH; Ronit Elk, PhD; Ted Gansler, MD, MBA; Keona Graves; Lovell Jones, PhD; Debbie Kirkland, BA; Brenda McNeal; Deepa Naishadham, MA, MS; Dearell Niemeyer, MPH; Barbara Powe, PhD, RN; Heather Rawls, MPH; Erin Reidy, MA; Cheri Richard, MS; Mona Shah, MPH; Scott Simpson; Robert Smith, PhD; Kevin Stein, PhD; Kristen Sullivan, MS, MPH; Michael Thun, MD, MS; and Elizabeth Ward, PhD. Cancer Facts & Figures for African Americans is a publication of the American Cancer Society, Atlanta, Georgia.
For more information, contact: Carol DeSantis, MPH Rebecca Siegel, MPH Ahmedin Jemal, PhD Surveillance Research
National Home Office: American Cancer Society Inc. 250 Williams Street, NW, Atlanta, GA 30303-1002 (404) 320-3333 ©2011, American Cancer Society, Inc. All rights reserved, including the right to reproduce this publication or portions thereof in any form. For written permission, address the Legal department of the American Cancer Society, 250 Williams Street, NW, Atlanta, GA 30303-1002.
This publication attempts to summarize current scientific information. Except when specified, it does not represent the official policy of the American Cancer Society. Suggested citation: American Cancer Society. Cancer Facts & Figures for African Americans 2011-2012. Atlanta: American Cancer Society, 2011.
Cancer Statistics
Figure 1. African American Population* (%) in the US by State, 2008
Introduction
New York (8.2%)
The Census Bureau estimates that in 2011 there are approximately 40.9 million African Americans living in the US, comprising 13 percent of the total population.1 The African American population is not homogenous and includes individuals whose ancestors were brought to the US as slaves, as well as more recent immigrants born in other countries. Of the approximately 3 million foreignborn African Americans, the majority were born in the Caribbean (54%) or Africa (34%). The African American population is not equally dispersed throughout the US, but is concentrated in New York, California, and the South (Figure 1). In 2008, 1 out of every 4 African Americans resided in New York, Florida, or Georgia.2
Florida (7.4%) All other states (41.4%)
Georgia (7.4%)
Texas (7.3%)
California (6.5%)
African Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers. The causes of these inequalities are complex and are thought to reflect social and economic disparities more than biologic differences associated with race. These include inequities in work, wealth, income, education, housing and overall standard of living, as well as barriers to high-quality cancer prevention, early detection, and treatment services.
North Carolina (5.1%) Michigan (3.7%) Virginia (4.0%)
Illinois (4.9%) Maryland (4.2%)
* Data limited to household population and exclude those living in institutions, dormitories, and other group quarters. Percentages do not total 100 due to rounding. Source: 2008 American Community Survey.2
Although the overall racial disparity in cancer death rates is decreasing, in 2007, the death rate for all cancers combined
Table 1. Leading Causes of Death among African Americans and Whites, 2007 All Ages Cause of Death Heart diseases Cancer Cerebrovascular diseases Accidents (unintentional injuries) Diabetes All causes
No. of Deaths (%) African American
White
African American
White
71,202 (24.6) 64,045 (22.1) 17,083 (5.9) 13,555 (4.7) 12,459 (4.3)
531,617 (25.6) 483,935 (23.3) 114,691 (5.5) 106,223 (5.1) 56,388 (2.7)
247.7 216.3 60.4 36.7 43.0
186.4 177.1 40.1 41.4 20.4
289,540
2,074,003
959.9
745.2
Children Ages 1-14 Cause of Death Accidents Homicide Cancer Congenital anomalies (birth defects) Heart diseases All causes
Death Rate*
No. of Deaths (%)
Death Rate*
African American
White
African American
White
784 (31.4) 308 (12.3) 198 (7.9)
2,794 (36.0) 413 (5.3) 1,063 (13.7)
8.6 3.3 2.2
6.3 0.9 2.4
196 (7.8) 106 (4.2)
670 (8.6) 278 (3.6)
2.1 1.2
1.5 0.6
2,500
7,767
27.2
17.5
*Rates are per 100,000 and age adjusted to the 2000 US standard population. Source: National Center for Health Statistics, Centers for Disease Control and Prevention, provided by the Surveillance, Epidemiology, and End Results Program.96
Cancer Facts & Figures for African Americans 2011-2012 1
Table 2. Death Rates* for Selected Cancers in African American Males and Females by State, 2003-2007
All Cancers
Lung & Bronchus
Colon & Rectum
Prostate
Breast
Uterine Cervix
Male
Female
Male
Female
Male
Female
Male
Female
Female
Alabama Alaska Arizona Arkansas California
330.9 258.5 213.3 344.3 277.3
173.7 124.5 153.6 186.7 187.0
97.2 † 62.1 113.2 76.7
32.5 † 37.6 35.7 41.9
33.3 † 23.8 34.3 28.1
21.0 † 15.6 24.4 21.6
68.0 † 32.9 64.2 52.3
32.3 † 27.3 33.4 33.4
5.4 † † 5.7 2.9
Colorado Connecticut Delaware District of Columbia Florida
246.8 248.2 279.7 314.7 261.0
146.0 159.8 184.2 185.6 158.4
63.7 64.9 83.9 85.7 70.5
34.4 30.1 52.1 40.8 28.1
24.8 24.3 26.8 32.2 26.8
16.1 18.6 19.3 21.2 18.9
45.1 43.9 50.1 52.0 54.2
20.7 27.4 25.4 31.8 29.7
† † † 4.9 4.6
Georgia Hawaii Illinois Indiana Iowa
296.3 125.5 323.7 321.1 331.8
166.9 † 206.3 200.1 188.4
84.6 † 96.1 102.0 116.2
32.2 † 50.3 52.5 49.0
29.4 † 36.2 32.7 38.4
20.6 † 24.6 22.0 †
61.2 † 58.9 53.0 60.5
30.4 † 36.9 35.1 30.9
4.4 † 5.6 3.9 †
Kansas Kentucky Louisiana Maryland Massachusetts
307.5 329.1 350.0 281.6 259.1
195.9 206.3 199.7 178.8 161.3
89.2 115.2 111.2 81.3 70.5
46.4 59.5 41.4 40.7 35.0
34.1 30.8 34.8 30.8 22.0
23.1 26.3 23.8 21.1 16.3
59.2 56.5 54.8 51.2 47.5
33.3 33.0 37.7 31.8 27.3
† 4.8 5.6 3.7 †
Michigan Minnesota Mississippi Missouri Nebraska
296.1 300.5 343.8 341.5 287.0
195.3 179.1 185.5 199.9 207.0
92.2 78.5 111.7 105.8 108.2
48.2 48.0 36.9 50.5 53.2
31.1 24.5 34.0 32.3 35.3
20.8 16.1 23.8 22.1 27.0
45.0 56.1 66.1 52.5 35.0
33.8 28.0 34.6 35.3 29.9
4.2 † 7.7 5.5 †
Nevada New Jersey New Mexico New York North Carolina
227.5 273.4 194.7 222.6 313.3
162.5 182.9 117.3 149.5 177.3
60.8 73.2 53.6 55.7 94.2
37.2 39.5 † 29.4 34.1
27.0 29.2 † 24.7 29.5
19.0 22.0 † 17.5 19.7
37.2 51.8 † 44.7 61.4
27.4 32.4 † 27.7 33.7
† 5.3 † 4.5 3.9
Ohio Oklahoma Oregon Pennsylvania Rhode Island
323.9 308.3 255.4 317.2 261.5
201.0 185.7 152.9 203.5 151.6
102.1 98.8 86.3 95.5 76.4
52.3 46.0 38.4 54.2 43.2
33.3 35.5 † 31.4 †
21.7 17.8 † 20.2 †
52.5 52.3 42.3 56.0 44.3
34.5 32.7 19.9 32.4 †
3.4 † † 4.1 †
South Carolina Tennessee Texas Utah Virginia
321.0 342.7 314.1 199.5 317.4
173.8 203.2 187.4 111.4 185.7
93.9 109.7 100.7 † 95.7
30.7 47.6 41.9 † 41.4
31.9 36.2 34.7 † 31.6
20.4 24.9 22.4 † 21.2
60.7 63.3 49.5 † 57.0
31.2 38.0 35.3 † 34.7
5.0 5.3 4.7 † 3.6
Washington West Virginia Wisconsin
244.8 283.5 340.5
178.3 186.2 198.5
67.7 78.3 117.8
43.6 38.7 52.5
26.6 34.9 28.6
21.3 27.6 19.6
40.6 55.3 48.4
25.7 33.9 26.5
† † 5.2
United States
296.5
180.6
87.5
39.6
30.5
21.0
54.2
32.4
4.4
* Rates are per 100,000 and age adjusted to the 2000 US standard population. † Rates are suppressed when they are based on fewer than 25 deaths. Note: Idaho, Maine, Montana, New Hampshire, North Dakota, South Dakota, Vermont, and Wyoming are not included in the table because fewer than 25 total cancer deaths occurred in these states among both African American men and women during 2003-2007. Source: National Center for Health Statistics, Centers for Disease Control and Prevention, provided by the Surveillance, Epidemiology, and End Results Program.96
2 Cancer Facts & Figures for African Americans 2011-2012
Figure 2. Leading Sites of New Cancer Cases and Deaths among African Americans, 2011 Estimates Estimated New Cases*
Estimated Deaths
Male
Female
Male
Female
Prostate 35,110 (40%)
Breast 26,840 (34%)
Lung & bronchus 9,740 (29%)
Lung & bronchus 7,050 (22%)
Lung & bronchus 12,930 (15%)
Lung & bronchus 10,290 (13%)
Prostate 5,300 (16%)
Breast 6,040 (19%)
Colon & rectum 7,940 (9%)
Colon & rectum 8,710 (11%)
Colon & rectum 3,520 (10%)
Colon & rectum 3,530 (11%)
Kidney 4,210 (5%)
Uterine corpus 4,430 (6%)
Pancreas 2,000 (6%)
Pancreas 2,320 (7%)
Non-Hodgkin lymphoma 2,850 (3%)
Thyroid 3,040 (4%)
Liver & intrahepatic bile duct 1,810 (5%)
Uterine corpus 1,450 (5%)
Liver & intrahepatic bile duct 2,780 (3%)
Pancreas 2,990 (4%)
Stomach 1,090 (3%)
Ovary 1,320 (4%)
Oral cavity & pharynx 2,550 (3%)
Kidney 2,880 (4%)
Leukemia 980 (3%)
Myeloma 890 (3%)
Pancreas 2,490 (3%)
Non-Hodgkin lymphoma 2,380 (3%)
Myeloma 900 (3%)
Uterine cervix 860 (3%)
Urinary bladder 2,240 (3%)
Uterine cervix 2,170 (3%)
Kidney 790 (2%)
Leukemia 850 (3%)
Leukemia 2,030 (2%)
Myeloma 1,940 (2%)
Esophagus 760 (2%)
Liver & intrahepatic bile duct 760 (2%)
All sites 88,860
All sites 80,040
All sites 33,900
All sites 31,640
*Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Note: Percentages may not total 100% due to rounding.
continued to be 32% higher in African American men and 16% higher in African American women than in white men and women, respectively. Similarly, African Americans bear a disproportionately high burden from other diseases. For example, the
©2011, American Cancer Society, Surveillance Research
death rate for heart diseases is 33% higher in African Americans than in whites. (Table 1, page 1). Consequently, life expectancy is lower for African Americans than whites among men (69.7 vs. 75.7 years) and women (76.5 vs. 80.6 years).3
Figure 3. Lung Cancer Death Rates* among African American Males and Females, 2003-2007 Males
Females
Rate per 100,000 105.8-117.8
Rate per 100,000 50.4-59.5
70.5-83.9
34.1-38.6
95.5-105.7
53.6-70.4
43.2-50.3
24.6-34.0
84.0-95.4
Insufficient data
38.7-43.1
Insufficient data
WA
WA MT
ND
ME MN
OR ID
SD
MI IA
NE
NV UT CA
AZ
PA IL
CO
NY
WI
WY
VT NH
KS
OK
NM
OH
IN
WV MO
VA
KY
MT ID
MA
TN
UT CA
KS
PA OH
IN
WV MO
VA
KY
MA RI CT
NJ DE MD DC
NC
TN AR
SC MS
GA
AL
GA
TX LA FL
HI
OK
NM
LA AK
IA IL
TX
VT NH
MI
CO
DC AZ
NY
WI
NE
NV
SC AL
SD WY
NC
AR MS
ME MN
RI CT NJ DE MD
ND
OR
AK
FL
HI
*Age adjusted to the 2000 US standard population. Note: Rates are suppressed when they are based on fewer than 25 deaths. Source: National Center for Health Statistics, Centers for Disease Control and Prevention, provided by the Surveillance, Epidemiology, and End Results Program.96
Cancer Facts & Figures for African Americans 2011-2012 3
How Many African Americans Alive Today Have Ever Had Cancer?
How Many New Cases and Deaths Are Expected to Occur among African Americans in 2011?
The National Cancer Institute estimates that approximately 942,400 African Americans with a history of cancer were alive in January 2007.4 Some of these individuals were cancer-free, while others still had evidence of cancer and may have been undergoing treatment.
About 168,900 new cancer cases are expected to be diagnosed among African Americans in 2011. The most commonly diagnosed cancers among African American men are prostate (40%), lung (15%), and colon and rectum (9%). Among African American women, the most common cancers are breast (34%), lung (13%), and colorectum (11%) (Figure 2, page 3).
Figure 4. Trends in Death Rates* for Selected Cancer Sites among African Americans and Whites, US, 1975 to 2007 Female All sites
400
400
350
350
300
300 Rate per 100,000
Rate per 100,000
Male All sites
250 200 150 100 50
250 200 150 100
0 1975
1980
1985
1990
1995
2000
2005
1975
Colon & rectum
1980
1985
1990
1995
2000
2005
1980
1985
1990
1995
2000
2005
1980
1985
1990
1995
2000
2005
Colon & rectum
50
50
45
45
40
40
35
35
Rate per 100,000
Rate per 100,000
White
50
0
30 25 20 15
30 25 20 15
10
10
5
5
0
0 1975
1980
1985
1990
1995
2000
2005
1975
Prostate
Breast
100
100
90
90
80
80
70
70
Rate per 100,000
Rate per 100,000
African American
60 50 40 30
60 50 40 30
20
20
10
10
0
0 1975
1980
1985
1990
1995
2000
2005
1975
*Rates are per 100,000 and age adjusted to the 2000 US standard population and are 2-year moving averages. Source: National Center for Health Statistics, Centers for Disease Control and Prevention, provided by the Surveillance, Epidemiology, and End Results Program.96
4 Cancer Facts & Figures for African Americans 2011-2012
About 65,540 African Americans are expected to die from cancer in 2011. Lung cancer accounts for the largest number of cancer deaths among both men (29%) and women (22%), followed by prostate cancer in men (16%) and breast cancer in women (19%) (Figure 2, page 3). For both men and women, cancers of the colorectum and pancreas are expected to rank third and fourth, respectively, as the leading sites for cancer deaths.
How Do Death Rates Vary by State? Table 2 (page 2) shows variations by state in the death rates for all cancers combined and selected cancer sites. For all cancers combined, the highest death rates among African American men are found in Louisiana, Arkansas, and Mississippi. Among African American women, the highest death rates are reported in Nebraska, Kentucky, and Illinois. Death rates for lung cancer, the leading cause of cancer death, are highest in Southern states (men) and the Midwest (women) (Figure 3, page 3).
How Has the Occurrence of Cancer Changed over Time? In African Americans, incidence rates for all cancers combined increased from the mid-1970s to the early 1990s, with a larger increase in men than in women. Since then, the rates have decreased in African American men (1.6% per year) and stabilized in African American women.4
Death rates among African Americans for all cancers combined have been decreasing since the early 1990s (Figure 4). The decline has been larger in men (2.5% per year since 1995) than in women (1.5% per year since 1999).4 A similar decline in death rates has been observed among whites since the early 1990s, with a greater reduction in the rate among men than women. Despite these declines, the death rates for all cancers combined continued to be substantially higher among African Americans than whites during 1975-2007, although the gap is much smaller among women (Figure 4). The racial difference in overall cancer death rates is due largely to cancers of the breast and colorectum in women and cancers of the prostate, lung and bronchus, and colorectum in men. However, in recent years, death rates for lung and other smoking-related cancers and for prostate cancer have decreased faster in African American men than white men, which has contributed to the recent narrowing of the racial disparity in overall cancer death rates.5 Notably, lung cancer death rates for young African Americans and whites have converged in both men and women (Figure 5).6 In contrast to the trends for prostate and smoking-related cancers, the racial disparity has widened for colorectal cancer in both men and women and for breast cancer in women (Figure 4).
Figure 5. Trends in Lung Cancer Death Rates* among Non-Hispanic White and Non-Hispanic African American Males and Females Aged 20-39, 1992-2007
Rate per 100,000
4.0
Male
4.0
3.5
3.5
3.0
3.0
2.5
2.5
2.0
2.0
1.5
1.5
1.0
1.0
0.5
0.5
0.0
1992
1994
1996
1998
2000
2002
2004
2007
0.0
African American
Female
1992
1994
1996
1998
2000
2002
2004
White
2007
*Rates are per 100,000 and age adjusted to the 2000 US standard population. Note: Dots represent observed data and straight lines represent fitted data. Source: Adapted from Jemal et al.6
Cancer Facts & Figures for African Americans 2011-2012 5
Figure 6. Five-year Relative Survival Rates* for Selected Cancers by Race and Stage at Diagnosis, 1999-2006 African American Female breast 100
100
93
90
85 78
Survival rate (%)
80
Esophagus
Colon & rectum
99
86
100
91
80
72
80
70
66
63 60
60
40
40
56
60
20
15
39
40
25 20
8
20
12
21
20
18
12
11 2
0
Localized
Regional
Distant
All Stages
0
Localized
Regional
Distant
All Stages
0
Oral cavity & pharynx
Lung & bronchus 100
100
80
80
White
100
Localized
Regional
100 100
100 100
3
Distant
All Stages
Prostate 96
100
Survival rate (%)
83
60
80
74
60
45 40
21
Regional
16
20
20
Distant
All Stages
0
Localized
Urinary bladder
Regional
Distant
80 74
0
Localized
60
Distant
All Stages
Uterine corpus
92
85
84
84 80
72 61
59
60
80
70 61
60
50 37
Regional
90
100
66
63
All Stages
Uterine cervix 100
40
30
4
100
80
29
24 13
Localized
40
32
24
3 0
42
37
40
20
Survival rate (%)
63
57
60
54
45
40
40
30 20
6 0
18
20
Localized
Regional
18
20
12
10
6
Distant
All Stages
0
Localized
Regional
Distant
All Stages
0
Localized
Regional
Distant
All Stages
Stage at diagnosis *Survival rates are based on patients diagnosed between 1999-2006 and followed through 2007. Local: An invasive cancer confined entirely to the organ of origin. Regional: A malignant cancer that either 1) has extended beyond the limits of the organ of origin directly into surrounding organs or tissues; 2) involves regional lymph nodes by way of lymphatic system; or 3) has both regional extension and involvement of regional lymph nodes. Distant: A malignant cancer that has spread to parts of the body remote from the primary tumor either by direct extension or by discontinuous metastasis to distant organs, tissues, or via the lymphatic system to distant lymph nodes. Source: Altekruse et al, 2010.4
6 Cancer Facts & Figures for African Americans 2011-2012
Cancer Survival and Stage Distribution
quality medical care, which results in later stage at diagnosis (Figure 7), as well as disparities in treatment.7-11 Identifying and understanding these and other factors has become an active and important area of research.
Five-year relative survival rates indicate the likelihood of surviving 5 years from the time of diagnosis, taking into account deaths from other causes. Survival rates are commonly used to monitor progress in the early detection and treatment of cancer. The overall 5-year relative survival rate among African Americans has improved from approximately 27% during 1960-1963 to 59% during 1999-2006.4 However, African Americans continue to be less likely than whites to survive 5 years at each stage of diagnosis for most cancer sites (Figure 6). Much of the difference in survival is believed to be due to barriers that prevent timely and high-
Although 5-year relative survival rates for all cancers combined are useful in monitoring trends over time and survival differences between groups, they are not useful for predicting individual prognosis because many important factors that influence individual survival are not reflected in the estimate. Five-year relative survival rates for specific cancers and factors that influence survival are discussed in the next section.
Figure 7. Stage Distribution for Selected Cancers in African Americans and Whites, 1999-2006 African American
Stage distribution (%)
Lung & bronchus 100
100
80
80
80
60
60
60
55
40
40
35
39
35
37
12
20
15 6
0
Localized
Regional
Distant
19
Unstaged
20
6
8 0
Localized
Female Breast
Regional
Distant
Unstaged
0
80
80
80
61
60
51
60
39
40
32
20
38
Localized
Regional
5
Distant
3
40
34
20
8
12
11
2
Unstaged
0
Localized
Regional
Distant
6
Regional
4
3
Distant
3
Unstaged
51
50 43
12
Urinary bladder 100
0
Localized
Uterine cervix 100
40
11
5
100
60
79 80
40
24
22 22 20
Stage distribution (%)
Prostate
Colon & rectum
100
60
White
20
6
4
Unstaged
0
37
40
35
12
7
7
4
5
3
In situ Localized Regional Distant Unstaged
Stage at diagnosis Percentages may not total 100% due to rounding. Source: Altekruse et al, 2010.4
Cancer Facts & Figures for African Americans 2011-2012 7
Selected Cancers Female Breast New Cases Breast cancer is the most commonly diagnosed cancer among African American women. An estimated 26,840 new cases of breast cancer are expected to occur among African American women in 2011. Breast cancer incidence rates increased rapidly among African American women during the 1980s (Figure 8), largely due to increased detection as the use of mammography screening increased. Incidence rates stabilized among African American women aged 50 and older during 1994-2007, while rates decreased by 0.6% per year from 1991-2007 among women under age 50.4 Between 2003-2007, the average annual breast cancer incidence rate in African American women was 114.7 cases per 100,000 women, which was 6% lower than in white women (Table 3, page 10). However, among younger women (under age 45), incidence rates are higher among African Americans than whites. Breast cancers diagnosed in African American women are more likely to have factors associated with poor prognosis, such as higher grade, distal stage, and negative hormone receptor status.12-14 Furthermore, premenopausal African American women appear to be at particular risk for basal-like breast cancer (i.e., triplenegative cancers), an aggressive subtype of breast cancer associated with shorter survival.12, 15 A woman’s best overall preventive health strategy is to reduce her known risk factors as much as possible by avoiding weight gain and obesity (for postmenopausal breast cancer), engaging in regular physical activity, and minimizing alcohol intake. Women should consider the increased risk of breast cancer associated with combined estrogen and progestin menopausal hormone therapy use when evaluating treatment options for menopausal symptoms.
Deaths Breast cancer is the second most common cause of cancer death among African American women, surpassed only by lung cancer. An estimated 6,040 deaths from breast cancer are expected to occur among African American women in 2011. Breast cancer death rates among African American women increased 1.5% annually from 1975-1992 and declined thereafter (Figure 9, page 11). This decrease was larger in women under 50 (2.0% per year) than in women aged 50 and older (1.2% per year).4 The steady decline in overall female breast cancer mortality since the early 1990s has been attributed to improvements in both early detection and treatment. However, breast cancer death rates have declined more slowly in African American women
8 Cancer Facts & Figures for African Americans 2011-2012
compared to white women, which has resulted in a growing disparity (Figure 4, page 4). During the early 1980s, breast cancer death rates for white and African American women were similar; yet in the period 2003-2007, African American women had a 39% higher death rate than white women, despite a lower incidence rate (Table 4, page 12). This difference accounts for more than one-third (37%) of the overall cancer mortality disparity between African American and white women. Factors that contribute to higher death rates among African American women include differences in access to and utilization of early detection and treatment, as well as differences in tumor characteristics.16-18
Survival and Stage Distribution The 5-year relative survival rate for breast cancer diagnosed in 1999-2006 among African American women was 78%, compared to 90% among white women. This difference can be attributed to both later stage at detection and poorer stage-specific survival among African American women (Figure 6, page 6). Only about half (51%) of breast cancers diagnosed among African American women are at a local stage, compared to 61% among white women (Figure 7, page 7). Later stage at diagnosis among African American women has been largely attributed to lower frequency of and longer intervals between mammograms, and lack of timely follow-up of suspicious results.19-21 Lower stage-specific survival has been explained in part by unequal receipt of prompt, high-quality treatment for African American women compared to white women.9, 22-24 There is also evidence that aggressive tumor characteristics are more common in African American than white women.12, 15, 25-26 Other studies suggest factors associated with socioeconomic status may influence the biologic behavior of breast cancer.14, 27-28 Thomson and colleagues found that among an all-white Scottish population, poor women were more likely than non-poor women to be diagnosed with estrogen receptor-negative breast tumors.29 Poverty likely influences disease pathology and genetic markers of disease through lifelong dietary and environmental exposures and reproductive habits. For more information about breast cancer, see the American Cancer Society publication Breast Cancer Facts & Figures, available online at cancer.org.
Cervix New Cases An estimated 2,170 cases of invasive cervical cancer are expected to be diagnosed among African American women in 2011. Incidence rates have decreased steadily over the past several decades in both African American and white women; however, the incidence rate of cervical cancer remains 39% higher in African American women (Figure 8; Table 3, page 10). Cervical cancer is one of only two cancers (colorectal is the other) that
The primary cause of cervical cancer is infection with certain types of human papillomavirus (HPV). The FDA has approved 2 vaccines (Gardisil and Cevarix) for the prevention of the most common HPV infections, which cause about 70% of cervical cancers. The American Cancer Society recommends routine HPV vaccination for girls aged 11 to 12 years and as early as age 9 years at the discretion of doctors.30 Vaccination is also recommended for females aged 13-18 years to catch up on missed vaccine or to complete the 3-dose series. Vaccinated women need to continue getting Pap tests because these vaccines target only the most common strains of HPV and do not provide protection for those who are already infected with HPV.
Figure 8. Age-adjusted Cancer Incidence Rates* for African Americans by Site and Sex, US, 1975 to 2007 350
Male
300 Prostate 250 Rate per 100,000
can actually be prevented through screening. As Pap screening has become more common, most cervical abnormalities are detected at a preinvasive stage rather than as invasive cancer. For more information on cervical cancer screening, see pages 18 and 24.
200 Lung & bronchus 150
100
Colon & rectum
50
Oral cavity & pharynx
0 1975
Survival and Stage Distribution
1980
1985
1990
1995
2000
2005
Female 150
120 Breast
Rate per 100,000
Deaths An estimated 860 deaths from cervical cancer are expected in 2011. Although mortality rates have declined steadily over the past several decades due to the prevention and early detection of cervical cancer as a result of screening (Figure 9, page 11), African American women remain twice as likely to die from cervical cancer as white women (Table 4, page 12).
Urinary bladder
90
Colon & rectum 60 Lung & bronchus 30
Uterine cervix
Uterine corpus
Pancreas
0 1975
1980
1985
1990
1995
2000
2005
Year of diagnosis
The overall 5-year relative survival rate *Rates are delay adjusted and age adjusted to the 2000 US standard population and are 2-year moving averages. for cervical cancer among African AmerSource: Surveillance, Epidemiology, and End Results (SEER) Program, 9 SEER Registries, Division of Cancer Control ican women is 61%, compared to 72% and Population Sciences, National Cancer Institute. among white women (Figure 6, page 6). African American women are also more likely to be diagnosed with regional- or Colon and Rectum distant-stage disease (Figure 7, page 7) despite similar screening New Cases rates reported in national surveys (Table 7, page 18). Racial difference in stage at diagnosis may be due to differences in the quality An estimated 16,650 cases of colorectal cancer are expected to of screening and follow-up after abnormal results.31-33 occur among African Americans in 2011. Colorectal cancer is the third most common cancer in both African American men
Cancer Facts & Figures for African Americans 2011-2012 9
Table 3. Comparison of Cancer Incidence Rates between African Americans and Whites, US, 2003-2007 Male Cancer
Female African American White Absolute Rate Rate* Rate* Difference† Ratio‡ Cancer
African American Rate*
White Absolute Rate Rate* Difference† Ratio‡
Kaposi sarcoma 1.9 0.7 1.2 2.64 Myeloma 13.3 6.5 6.8 2.06 Stomach 16.4 8.7 7.7 1.89 Larynx 11.1 6.8 4.3 1.63 Liver & intrahepatic bile duct 13.4 8.2 5.2 1.62 Prostate 229.4 143.5 85.9 1.60 Breast 1.8 1.3 0.5 1.35 Pancreas 16.4 13.0 3.4 1.26 Lung & bronchus 104.0 84.8 19.2 1.23 Colon & rectum 67.2 56.1 11.1 1.20 Esophagus 10.1 8.7 1.4 1.16 Kidney & renal pelvis 21.6 20.2 1.4 1.07 Oral cavity & pharynx 16.7 16.1 0.6 1.04 Soft tissue (including heart) 3.5 3.7 -0.2 0.93 Hodgkin lymphoma 2.9 3.3 -0.4 0.90 Leukemia 12.1 16.3 -4.2 0.74 Non-Hodgkin lymphoma 16.8 23.7 -6.9 0.71 Brain & other nervous system 4.7 8.4 -3.7 0.56 Thyroid 2.7 5.4 -2.7 0.51 Urinary bladder 18.7 39.6 -20.9 0.47 Testis 1.3 6.2 -4.9 0.21 Melanoma of the skin 1.1 25.4 -24.3 0.04
Kaposi sarcoma 0.2 Myeloma 9.6 Stomach 8.3 Esophagus 3.1 Uterine cervix 10.8 Liver & intrahepatic bile duct 3.9 Pancreas 13.5 Larynx 2.0 Colon & rectum 50.9 Soft tissue (including heart) 3.2 Kidney & renal pelvis 11.1 Breast 114.7 Lung & bronchus 51.8 Oral cavity & pharynx 5.4 Uterine corpus 21.3 Hodgkin lymphoma 2.2 Leukemia 7.6 Ovary 9.7 Non-Hodgkin lymphoma 11.6 Urinary bladder 6.7 Thyroid 9.3 Brain & other nervous system 3.6 Melanoma of the skin 1.0
0.1 4.0 4.1 1.9 7.7 2.8 9.9 1.5 41.4 2.7 10.7 121.7 57.1 6.1 24.3 2.6 9.9 13.3 16.7 10.0 15.8 6.1 16.9
0.1 5.6 4.2 1.2 3.1 1.1 3.6 0.5 9.5 0.5 0.4 -7.0 -5.3 -0.7 -3.0 -0.4 -2.3 -3.6 -5.1 -3.3 -6.5 -2.5 -15.9
3.43 2.38 2.02 1.62 1.39 1.37 1.36 1.32 1.23 1.19 1.04 0.94 0.91 0.89 0.88 0.83 0.77 0.73 0.69 0.67 0.59 0.59 0.06
All Sites
All Sites
413.2
-24.8
0.94
616.8
536.5
80.3
1.15
388.3
* Rates are per 100,000 and age adjusted to the 2000 US standard population. † Absolute difference is the rate in African Americans minus the rate in whites. ‡ Rate ratio is the rate in African Americans divided by the rate in whites based on two decimal places. Source: North American Association of Central Cancer Registries.95
and women. Incidence rates have been slowly decreasing among African American women since 1980 (0.4% per year), while a more rapid decline (4.8% per year) occurred among men during the most recent time period (2003-2007) (Figure 8, page 9).4 Prior to 1989, incidence rates were predominantly higher in white men than in African American men and were similar for women of both races. Since 1989, however, incidence rates have been higher for African Americans than whites in both men and women. This crossover may reflect racial differences in the trends in the prevalence of risk factors for colorectal cancer and/ or greater access to and utilization of recommended screening tests by whites that detect and remove precancerous polyps. Major modifiable factors that increase risk for colorectal cancer include physical inactivity, obesity, high consumption of red or processed meats, and smoking. Studies consistently report that regular physical activity (occupational or recreational) is associated with a lower risk of colon cancer.34-36 In November 2009, the
International Agency for Research on Cancer reported that there is now sufficient evidence to conclude that tobacco smoking causes colorectal cancer.37 Non-modifiable risk factors for colorectal cancer include a personal or family history of adenomatous polyps or colorectal cancer and a personal history of chronic inflammatory bowel disease. Colorectal cancer risk is also increased by certain inherited genetic conditions (Lynch syndrome, formerly known as hereditary non-polyposis colorectal cancer [HNPCC], and familial adenomatous polyposis [FAP]). Screening tests that detect and remove adenomatous polyps are the most reliable method of preventing colorectal cancer; however, colorectal cancer screening rates remain suboptimal among African Americans. The American Cancer Society has identified increasing colorectal screening as a priority for cancer prevention and control. For more information on colorectal cancer screening, see page 18.
10 Cancer Facts & Figures for African Americans 2011-2012
Since the early 1980s, there has been an increasing divergence in colorectal cancer mortality rates between whites and African Americans due to slower declines in African Americans. Before 1980, colorectal cancer mortality rates were lower in African American men than white men and similar among women of both races; however, since that time, mortality rates have been higher in African Americans (Figure 4, page 4). Higher death rates from colorectal cancer account for about one-fourth (24%) of the current disparity in overall cancer death rates between African American and white women and 14% of the disparity between African American and white men.
Survival and Stage Distribution
Figure 9. Age-adjusted Cancer Death Rates* for African Americans by Site and Sex, US, 1975 to 2007 150
Male
Lung & bronchus 120
Rate per 100,000
An estimated 7,050 deaths from colorectal cancer are expected to occur among African Americans in 2011. Colorectal cancer is the third leading cause of cancer death in both African American men and women. Death rates for colorectal cancer began to decline gradually in 1985 among African American women, with a steeper decline occurring from 2001 to 2007 (3.4% per year).4 Among African American men, the decline began slowly in 1990; more recently (2000-2007), the decrease averaged 2.2% per year.4 The decrease in both men and women reflects declining incidence rates and improvements in early detection and treatment.
90 Prostate
60 Colon & rectum 30 Pancreas Stomach 0 1975
1980
1985
1990
1995
2000
2005
Year of death 50
Female
Lung & bronchus 40 Breast Rate per 100,000
Deaths
30 Colon & rectum 20 Pancreas 10 Ovary
Uterine cervix
The 5-year relative survival rate for 0 colorectal cancer among African 1975 1980 1985 1990 1995 2000 2005 Year of death Americans improved from 46% in 19751977 to 57% in 1999-2006; however, this *Rates are age adjusted to the 2000 US standard population and are 2-year moving averages. improvement was smaller than that in Source: National Center for Health Statistics, Centers for Disease Control and Prevention, provided by the Surveillance, Epidemiology, and End Results Program.96 whites (51% to 68% over the same period).4 Some of the disparity in survival is due to later stage at diagnosis among African Americans – 35% of colorectal treatment and possibly differences in tumor biology.38-39 Several cancers in African Americans are diagnosed at a localized stage, studies document that African Americans with colorectal compared to 39% in whites (Figure 7, page 7). However, lower cancer are less likely than white patients to receive recommended 5-year relative survival rates are also seen in African Americans surgical treatment and adjuvant therapy;40-41 however, a recent within each stage at diagnosis (Figure 6, page 6), presumably national study suggests the disparity is decreasing.42 reflecting disparities in access to and receipt of high-quality
Cancer Facts & Figures for African Americans 2011-2012 11
Table 4. Comparison of Cancer Death Rates between African Americans and Whites, US, 2003-2007 Male Cancer
Female African American White Absolute Rate Rate* Rate* Difference† Ratio‡ Cancer
African American Rate*
Prostate 54.2 22.8 31.4 2.38 Stomach 10.7 4.6 6.1 2.31 Larynx 4.6 2.0 2.6 2.24 Myeloma 8.1 4.2 3.9 1.94 Oral cavity & pharynx 6.3 3.7 2.6 1.72 Breast 0.5 0.3 0.2 1.71 Liver & intrahepatic bile duct 11.1 7.0 4.1 1.59 Colon & rectum 30.5 20.6 9.9 1.48 Lung & bronchus 87.5 68.3 19.2 1.28 Pancreas 15.4 12.2 3.2 1.26 Esophagus 8.9 7.9 1.0 1.13 Kidney & renal pelvis 6.0 6.0 0.0 1.00 Soft tissue (including heart) 1.4 1.5 -0.1 0.94 Hodgkin lymphoma 0.5 0.6 -0.1 0.93 Leukemia 8.4 10.0 -1.6 0.84 Urinary bladder 5.4 7.9 -2.5 0.69 Thyroid 0.3 0.5 -0.2 0.69 Non-Hodgkin lymphoma 6.0 9.1 -3.1 0.67 Testis 0.2 0.3 -0.1 0.58 Brain & other nervous system 3.1 5.6 -2.5 0.55 Melanoma of the skin 0.5 4.5 -4.0 0.12
Myeloma Stomach Uterine cervix Uterine corpus Small intestine Esophagus Larynx Colon & rectum Breast Pancreas Liver & intrahepatic bile duct Urinary bladder Soft tissue (including heart) Thyroid Oral cavity & pharynx Kidney & renal pelvis Lung & bronchus Leukemia Hodgkin lymphoma Ovary Non-Hodgkin lymphoma Brain & other nervous system Melanoma of the skin
All sites
All sites
296.5
222.5
74.0
1.33
White Absolute Rate Rate* Difference† Ratio‡
5.8 5.0 4.4 7.2 0.5 2.5 0.7 21.0 32.4 12.4 3.9 2.7 1.4 0.5 1.6 2.7 39.6 5.0 0.3 7.2 3.9 2.0 0.4
2.7 2.4 2.2 3.9 0.3 1.6 0.5 14.4 23.4 9.1 3.0 2.2 1.1 0.5 1.4 2.7 41.6 5.6 0.4 8.9 5.7 3.8 2.0
3.1 2.6 2.2 3.3 0.2 0.9 0.2 6.6 9.0 3.3 0.9 0.5 0.3 0.0 0.2 0.0 -2.0 -0.6 -0.1 -1.8 -1.8 -1.8 -1.6
2.19 2.11 2.01 1.87 1.75 1.58 1.56 1.46 1.39 1.36 1.32 1.22 1.21 1.17 1.09 0.97 0.95 0.90 0.86 0.80 0.68 0.54 0.21
180.6
155.0
25.6
1.17
* Rates are per 100,000 and age adjusted to the 2000 US standard population. † Absolute difference is the rate in African Americans minus the rate in whites. ‡ Rate ratio is the rate in African Americans divided by the rate in whites based on two decimal places. Source: National Center for Health Statistics, Centers for Disease Control and Prevention, provided by the Surveillance, Epidemiology, and End Results Program.96
For more information on colorectal cancer, see the American Cancer Society publication Colorectal Cancer Facts & Figures, available online at cancer.org.
Lung and Bronchus New Cases An estimated 23,220 cases of lung cancer are expected to occur among African Americans in 2011, accounting for about 14% of the cancer diagnoses in this group. Cancer of the lung is the second most common cancer in both African American men and women. The average incidence rate for cancers of the lung and bronchus during 2003-2007 was 23% higher in African American men than in white men; however, it was 9% lower in African American women than white women (Table 3, page 10). After increasing for many decades, the rate of lung cancer among African American men has been decreasing since the mid-1980s (Figure 8, page 9). The incidence rate of lung cancer among African American women has been stable since 1990.
Deaths An estimated 16,790 deaths from lung cancer are expected to occur among African Americans in 2011. Lung cancer kills more African Americans than any other cancer. Lung cancer death rates in men began to decline in 1990, with an acceleration in the decline beginning in 1995 (2.8% per year during 1995-2007).4 The death rate in women has been relatively stable since 1998. The decline in lung cancer death rates in men and leveling off of rates in women are the result of decreases in smoking prevalence over the previous 40 years. The disparity in lung cancer death rates between African American and white men has been substantially reduced overall (from an excess of 50% in 1990-1992 to 28% in 2003-2007) and has been eliminated in younger adults (under age 40). The convergence of lung cancer death rates between young African American and white adults is the result of faster declines in African Americans (Figure 5, page 5), likely reflecting the greater decrease in smoking initiation among African Americans since the late 1970s,
12 Cancer Facts & Figures for African Americans 2011-2012
Table 5. Lifetime Probability of Developing or Dying from Invasive Cancers by Race and Sex, US, 2005-2007
Developing
Dying
African American (%)
White (%)
African American (%)
White (%)
All Sites*
Male Female
40.35 (1 in 2) 33.01 (1 in 3)
44.35 (1 in 2) 38.59 (1 in 3)
23.49 (1 in 4) 19.26 (1 in 5)
23.32 (1 in 4) 19.80 (1 in 5)
Prostate
Male
18.52 (1 in 5)
15.67 (1 in 6)
4.45 (1 in 22)
2.62 (1 in 38)
Breast
Female
10.21 (1 in 10)
12.57 (1 in 8)
3.23 (1 in 31)
2.79 (1 in 36)
Lung & bronchus
Male Female
7.65 (1 in 13) 5.55 (1 in 18)
7.76 (1 in 13) 6.66 (1 in 15)
6.83 (1 in 15) 4.20 (1 in 24)
7.04 (1 in 14) 5.24 (1 in 19)
Colon & rectum
Male Female
4.91 (1 in 20) 5.19 (1 in 19)
5.30 (1 in 19) 4.90 (1 in 20)
2.44 (1 in 41) 2.34 (1 in 43)
2.14 (1 in 47) 1.97 (1 in 51)
Uterine corpus
Female
2.06 (1 in 49)
2.69 (1 in 37)
0.81 (1 in 124)
0.50 (1 in 200)
Kidney
Male Female
1.64 (1 in 61) 1.07 (1 in 93)
1.95 (1 in 51) 1.17 (1 in 85)
0.48 (1 in 209) 0.30 (1 in 337)
0.62 (1 in 162) 0.36 (1 in 278)
Urinary bladder
Male Female
1.59 (1 in 63) 0.82 (1 in 123)
4.13 (1 in 24) 1.22 (1 in 82)
0.47 (1 in 213) 0.34 (1 in 298)
0.90 (1 in 111) 0.33 (1 in 299)
Pancreas
Male Female
1.33 (1 in 75) 1.64 (1 in 61)
1.42 (1 in 71) 1.39 (1 in 72)
1.23 (1 in 81) 1.44 (1 in 69)
1.29 (1 in 77) 1.25 (1 in 80)
Non-Hodgkin lymphoma
Male Female
1.25 (1 in 80) 1.16 (1 in 87)
2.43 (1 in 41) 2.03 (1 in 49)
0.47 (1 in 212) 0.41 (1 in 245)
0.93 (1 in 107) 0.78 (1 in 129)
Uterine cervix
Female
0.79 (1 in 127)
0.66 (1 in 152)
0.41 (1 in 247)
0.21 (1 in 467)
*All sites excludes basal and squamous cell skin cancers and in situ cancers except urinary bladder. Note: Percentages and “1 in” numbers may not be equivalent due to rounding. Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.5.0.97
which resulted in a more rapid decrease in smoking prevalence in African Americans aged 25-34 years compared to whites. 6 , 43-44 If young African Americans continue to have low smoking prevalence as they get older, racial differences in lung cancer death rates should be eliminated among men in the next 40 to 50 years.
Survival and Stage Distribution The 5-year relative survival rate for lung cancer is lower in African Americans than in whites: 13% and 16%, respectively (Figure 6, page 6). When lung cancer is detected at a localized stage, the 5-year relative survival rate among African Americans is 45%; however, only 12% of lung cancer cases are detected at this early stage because symptoms generally do not appear until the disease is advanced. Studies have shown that when lung cancer is diagnosed early, African Americans are less likely than whites to receive surgery, the treatment with the best chance for cure, even after accounting for socioeconomic factors.8 However, a study within the military health care system, where access to medical care is universal, found no disparity in lung cancer treatment or survival between African Americans and whites.45
Prostate New Cases An estimated 35,110 cases of prostate cancer are expected to occur among African American men in 2011, accounting for 40% of all cancers diagnosed in African American men. It is estimated that 1 in 5 African American men will be diagnosed with prostate cancer in their lifetime (Table 5). Between 20032007, the average annual prostate cancer incidence rate among African American men was 229.4 cases per 100,000 men, which was 60% higher than the rate in white men (Table 3, page 10). Similar to the pattern in whites, incidence rates of prostate cancer in African American men increased sharply between 1989 and 1992, but have since been declining (Figure 8, page 9). The dramatic rise in prostate cancer incidence rates was likely due to increased use of the prostate-specific antigen (PSA) blood test. The only well-established risk factors for prostate cancer are age, race, and family history of the disease. African American men and Jamaican men of African descent have the highest prostate cancer incidence rates worldwide. The reasons for this are not clear, but may in part reflect genetic factors that vary in populations originating in different parts of the world.46-47
Cancer Facts & Figures for African Americans 2011-2012 13
Deaths Prostate cancer is the second leading cause of cancer death in African American men. It is estimated that 5,300 deaths from prostate cancer will occur in African American men in 2011. African American men have the highest mortality rate for prostate cancer of any racial or ethnic group in the US. The death rate for prostate cancer is 2.4 times higher in African American men than in white men (Table 4, page 12). This difference accounts for 44% of the overall cancer mortality disparity between African American and white men. Prostate cancer death rates also vary by years of education. In a study of death rates among men aged 25 to 64 by level of education, American Cancer Society researchers found that the prostate cancer death rate for African American men with 12 or fewer years of education was twice that of men with more than 12 years of education.48 After a long period of increase, prostate cancer death rates in African American men peaked in 1993 and declined steadily thereafter.4 Some of the decrease in prostate cancer mortality may be due to improved surgical and radiologic treatment, dissemination of hormonal therapy for advanced-stage disease, and early detection by PSA.49-55 However, the contribution of PSA testing is not clear. A recent US-based randomized trial failed to show any benefit of PSA testing in reducing deaths from prostate cancer, while two European trials showed a modest benefit.56-58
Survival and Stage Distribution The overall 5-year relative survival rate for prostate cancer among African Americans is 96%, compared to nearly 100% among whites (Figure 6, page 6). Ninety percent of all prostate cancers among African Americans are diagnosed at the local and regional stages, compared to 92% in whites (Figure 7, page 7); the 5-year relative survival rate for African Americans whose tumors are diagnosed at these early stages approaches 100%. Among African American men, 5-year survival rates drop to 29% when the cancer has spread to distant sites. For more information on prostate cancer, see the Special Section of the American Cancer Society publication Cancer Facts & Figures 2010, available online at cancer.org.
Risk Factor Statistics Socioeconomic Status Socioeconomic status (SES) is highly correlated with cancer risk and outcomes across the continuum from prevention to palliative care. Persons with lower SES are more likely to engage in behaviors that increase cancer risk, such as tobacco use and physical inactivity, in part because of marketing strategies that target these populations and in part because of environmental and community factors, such as fewer opportunities for physical activity and less access to fresh fruits and vegetables. Lower SES is also associated with financial, structural, and personal barriers to health care, including lack of or inadequate health insurance, reduced access to recommended preventive care and treatment services, and lower literacy levels. Individuals with no health insurance and those with Medicaid insurance are more likely to be diagnosed with advanced cancer.7 These factors disproportionately impact African Americans because compared with 9% of whites, 25% of African Americans live below the federal poverty threshold.59 In addition, 19% of African Americans are uninsured, while only 11% of whites lack health insurance.59 No single factor (such as education or income) fully captures all of the important characteristics that may influence the association between SES and health, but for most cancers, risk is inversely related to SES, regardless of which measure is used. Moreover, factors associated with SES contribute to substantial differences in cancer incidence and mortality within, as well as among, racial and ethnic groups.60 Persons with lower SES have higher cancer death rates than those with higher SES, regardless of demographic factors such as race/ethnicity. For example, for all cancer sites combined, mortality rates among both African American and white men with 12 or fewer years of education are more than twice those in men with higher levels of education.48 Similarly, death rates for each of the 4 major cancer sites are higher in African American men and women with fewer years of education than in those with more years of education. Furthermore, progress in reducing cancer death rates has been slower among persons with lower SES.61
Tobacco Use Smoking is the most preventable cause of premature death in the US and is responsible for about 30% of all cancer deaths.62-63 Smoking is associated with increased risk of at least 16 types of cancer: nasopharynx, nasal cavity and paranasal sinuses, lip, oral cavity, pharynx, larynx, lung, esophagus, pancreas, uterine cervix, kidney, bladder, stomach, colorectal, and acute myeloid
14 Cancer Facts & Figures for African Americans 2011-2012
Figure 10. Trends in Cigarette Smoking (%), Adults 18 and Older, US, 1990-2009 40 African American males 35 White males 30
Percent
25
20 White females
African American females 15
10
5 0 1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Data for 1996 not available. Source: 1990-2007: Health, United States, 2009 (Spreadsheet Version). 2008-2009: National Health Interview Survey Public Use Data Files 2008 and 2009.
leukemia.37, 64 Both incidence and death rates for lung cancer are higher among African American men than among white men, due in part to differences in historical smoking behaviors. For most of the past 4 decades, the rate of adult smoking has been higher in African American men than in white men, though in recent years rates have converged.
Adult Cigarette Smoking In 2009, the prevalence of current cigarette smoking among African American adults was higher in men (23.1%) than women (18.5%) (Figure 10). In both groups, the prevalence is much higher than the Healthy People 2020 goal of 12%.
Youth Tobacco Use For more than a decade, African American high school students have had a lower prevalence of cigarette smoking than other racial and ethnic groups. According to the Youth Risk Behavior Surveillance Survey, the prevalence of current cigarette smoking among African American high school students peaked in 1997 in boys and 1999 in girls and has since been generally decreasing (Figure 11, page 16). As of 2009, 10.7% of African American boys and 8.4% of African American girls smoke cigarettes, compared to 22.3% of white boys and 22.8% of white girls.65
Overweight, Obesity, and Physical Activity Overweight and Obesity Obesity is a major heath problem in the US. In addition to diabetes, heart disease, and stroke, obesity increases the risk of many cancers, including cancers of the breast (in postmenopausal women), colon, endometrium, kidney, and adenocarcinoma of the esophagus.66-68 Evidence is highly suggestive that obesity also increases the risk for cancers of the pancreas, gallbladder, thyroid, ovary, and cervix, as well as for myeloma, Hodgkin lymphoma, and aggressive forms of prostate cancer.68-71 Increasing evidence also suggests that being overweight increases the risk of cancer recurrence, decreases the likelihood of survival for many cancers, and increases the risk of developing other illnesses following a cancer diagnosis.69, 72-74 According to the definition of obesity (BMI ≥30 kg/m2), 44% of African American adults are considered obese and 74% of African American adults are considered overweight (BMI 25.0-29.9 kg/m2) or obese.76 Overweight and obesity are more common among African American women and girls than white women and girls, while there is little racial difference among men and boys (Figure 12, page 17). The proportion of African American women who are obese has increased from 31% in 1976-1980 to 50% in 2007-2008.
Cancer Facts & Figures for African Americans 2011-2012 15
Nutrition and Diet
Table 6. Leisure-time Physical Activity in Adults (18+ years) by Race and Sex, US, 2008
The American Cancer Society recommends choosing food and beverages in amounts that help achieve and maintain a healthy weight. Specifically, the guidelines suggest eating 5 or more servings of a variety of vegetables and fruits each day, choosing whole grains in preference to processed (refined) grains, and limiting consumption of processed and red meats.77
There is strong scientific evidence that healthy dietary patterns, in combination with regular physical activity, are needed to maintain a healthy body weight and to reduce cancer risk. Many epidemiologic studies have shown that populations that eat diets high in vegetables and fruits and low in animal fat, meat, and/or calories have reduced risk of the most common cancers.68 Moreover, evidence that a diet high in red and processed meat is associated with a higher risk of developing gastrointestinal cancers has increased over the years.78-80 Despite the known benefits of a healthy diet, many Americans are not following these recommendations. The Society, in partnership with the National Cancer Institute and the Centers for Disease Control and Prevention, is working with churches to encourage healthy eating in the African American community through the Body & Soul – A Celebration of Healthy Eating and Living program.
Non-Hispanic Non-Hispanic African American (%) White (%)
Inactive* Both sexes Male Female
47.7 41.8 52.6
32.1 30.4 33.5
Some leisure-time physical activity† Both sexes Male Female
27.5 27.0 27.6
32.0 31.6 32.5
Regular leisure-time physical activity‡ Both sexes 24.8 Male 31.1 Female 19.8
35.9 38.0 34.0
Note: Leisure-time physical activity does not include physical activity that occurs at the workplace. Estimates are age adjusted to the 2000 US standard population. * No physical activity of at least 10 minutes per week; † At least one session per week of light/moderate or vigorous physical activity of at least 10 minutes duration. ‡ Three or more sessions per week of vigorous activity lasting at least 20 minutes, or 5 or more sessions per week of light/moderate activity lasting at least 30 minutes. Source: National Health Interview Survey, 2008.82
Figure 11. Trends in the Percentage of Current Cigarette Smokers, Non-Hispanic African American High School Students, US, 1991-2009 Male 30 27.8
Female 30
28.2
25
25 21.8 19.3
20
20
Percent
17.4 15
17.7
16.3
16.3 14.1
14.0
14.9
14.4
15 11.3
10.7 10
10
5
5
0
13.3 12.2
11.9 10.8 8.4
8.4
0 1991
1993
1995
1997
1999
2001 2003 2005 2007 2009
1991
Year Source: Cigarette use among high school students - United States, 1991-2009.65
16 Cancer Facts & Figures for African Americans 2011-2012
1993
1995
1997
1999
2001 2003 2005 2007 2009
Physical Activity Studies have shown that regular physical activity is associated with lower risk of several types of cancer, including cancers of the breast, colon, prostate, and endometrium.66, 81 The American Cancer Society recommends that adults engage in at least 30 minutes of moderate-to-vigorous physical activity, above usual activities, on 5 or more days of the week and 45 to 60 minutes of intentional physical activity is preferable.77 Data from the 2008 National Health Interview Survey (NHIS) shows that just under one-half of African American adults report no leisure-time physical activity, with African American women more likely than men to be physically inactive (52.6% vs. 41.8%, respectively) (Table 6).82 While the level is low for both sexes, African American men were more likely than African American women to report regular, leisure-time physical activity (31.1% vs. 19.8%, respectively). It is important to note that these estimates do not include physical activity that occurs at the workplace.
linked to overweight and obesity.77, 83-85 Although healthy eating and physical activity are a matter of individual choice, the local food environment (e.g., fast-food outlet density versus supermarkets) and built-environment features (e.g., accessibility to parks, gyms, or other recreational settings) can influence individuals’ choice and ability to adopt a healthy lifestyle.83-87 Therefore, the American Cancer Society nutrition and physical activity guidelines include recommendations for communitylevel actions. They suggest the need for public, private, and community organizations to work together to facilitate and promote policies to effect changes in social and physical environments in order to enable people to adopt and maintain healthy nutrition and physical activity behaviors.77 Specifically, community-level actions are needed to: (1) increase access to healthy foods in schools, worksites, and communities; (2) provide safe, enjoyable spaces for physical activity in schools; (3) provide safe, physically active transportation (such as biking and walking) and recreation in communities.
Community Strategies There is growing recognition that multiple aspects of social environments where people live, work, and play appear to be
Figure 12. Prevalence of Overweight and Obesity in Adolescents and Adults by Sex and Race, US, 2007-2008 African American 100
Prevalence of Overweight or Obesity* in Adolescents
Prevalence (%)
80
100 80
Prevalence of Overweight or Obesity‡ in Adults 73.8 66.7
60
72.6
68.5
78.2 61.2
60 46.3
40
39.5 31.3
33.0
32.6
29.9
20 0
40 20
Both sexes
100
Prevalence (%)
White
Boys
0
Girls
Both sexes
100
Prevalence of Obesity† in Adolescents
80
80
60
60
Men
Women
Prevalence of Obesity§ in Adults
49.6
44.1
40 20 0
40
29.2
24.4 15.6
Both sexes
19.8
16.7
Boys
14.5
Girls
32.4
37.3
31.9
33.0
20 0
Both sexes
Men
Women
Note: Adolescents are ages 12-19 years, and adults are ages 20 and over. *BMI for Age > 85th percentile. †BMI for Age > 95th percentile. ‡BMI > 25. §BMI > 30. Source: Data for adolescents were previously published in Odgen et al, 2010.75 Data for adults were previously published in Flegal et al, 2010.76
Cancer Facts & Figures for African Americans 2011-2012 17
Use of Screening Tests
Table 7. Use of Cancer Screening Tests, 2008
Screening tests are used to detect some cancers at stages when they are still highly curable. In fact, for cancers of the cervix and colorectum, early detection tests can lead to the prevention of the disease through the identification and removal of precancerous lesions. Screening can also detect cancer at an earlier stage, which can reduce the extent of treatment, improve the chances of cure, extend life, and thereby improve the quality of life for cancer survivors.
Breast and Cervical Cancer Screening The American Cancer Society recommends that average-risk women aged 40 and older get annual mammograms, as well as regular clinical breast exams.88 (See screening guidelines, page 25.) For women at high risk for breast cancer, the Society recommends annual screening using magnetic resonance imaging (MRI) in addition to mammograms beginning at age 30; the high-risk status of these women (lifetime risk approximately 20%-25% or greater) is based on the presence of mutations in the breast cancer susceptibility genes, BRCA1 and BRCA2, strong family history of breast and/or ovarian cancer suggesting a high probability of being a mutation carrier, or prior chest radiation therapy (e.g., for Hodgkin disease).88 Since 1987, mammography use has been increasing in all racial and ethnic groups.89 In 2008, the proportion of African American women aged 40 and older who reported receiving a mammogram within the past 2 years was 67.7%; however, only 52.2% of African American women reported having a mammogram within the past year (Table 7). Despite generally similar screening rates, breast cancer is detected at an advanced stage more often in African American than in white women (Figure 7, page 7). This difference has been largely attributed to lower frequency of and longer intervals between mammograms, and lack of timely follow-up of suspicious results.19-21, 90 The American Cancer Society recommends that all women begin cervical cancer screening about three years after they begin having vaginal intercourse, but no later than age 21. (See screening guidelines, page 25.) In 2008, the rate of Pap testing within the previous 3 years was similar among African American (81.5%) and white women (79.6%). However, among women of all races, screening rates are lower in older women, women with no health insurance, and recent immigrants.91 The Centers for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was begun in 1990 to improve access to breast cancer screening
Non-Hispanic Non-Hispanic African American (%) White (%)
Breast cancer (women 40 and older) Mammogram within past year within past 2 years
52.2 67.7
54.2 68.0
Cervical cancer (women 18 and older) Pap test*
81.5
79.6
Colon & rectum (adults 50 and older) Endoscopy† 47.3 Fecal occult blood test (FOBT)‡ 8.9 FOBT or endoscopy§ 48.9
52.7 10.3 56.0
Prostate cancer Prostate specific antigen (PSA) test¶
46.6
38.6
Percentages are age adjusted to the 2000 US standard population. * Pap test within the past 3 years. † Flexible sigmoidoscopy within 5 years or colonoscopy within 10 years. ‡ Home FOBT within past year. § Home FOBT within past year, or flexible sigmoidoscopy within 5 years, or colonoscopy within 10 years. ¶ PSA test within past year for men 50 and older who had not been diagnosed with prostate cancer. Source: National Health Interview Survey, Public Use Data File, 2008.
and diagnostic services for low-income women. This program, now available in all 50 states, the District of Columbia, 5 US territories, and 12 American Indian/Alaska Native tribal organizations, helps low-income, uninsured, and underinsured women gain access to breast and cervical cancer screening and diagnostic services. However, according to a 2006 study, only 15% of women eligible through the program received a screening mammogram, and only 6% of eligible women were screened for cervical cancer.92 The American Cancer Society is committed to helping increase funding for NBCCEDP in order to reach more eligible women. (See page 22 for more information on the NBCCEDP.)
Colorectal Cancer Screening The American Cancer Society recommends that both men and women at average risk of developing colorectal cancer should choose one of the several available screening methods beginning at age 50. (See screening guidelines, page 25.) Individuals at increased or high risk of developing the disease (e.g. those with a personal or family history of colorectal cancer or polyps, chronic inflammatory bowel disease, or inherited genetic mutations) should discuss their risk status with their physician to determine whether earlier and/or more intensive screening is indicated.
18 Cancer Facts & Figures for African Americans 2011-2012
The use of colorectal screening tests among African Americans has increased over the past several years. In 1987, only 18% of African American women and 15% of African American men reported having had a recent colorectal screening test.93 By 2008, the prevalence of a recent screening for colorectal cancer among African Americans had increased to 49%, compared to 56% in whites (Table 7).
How the American Cancer Society Helps Save Lives and Helps Reduce Cancer Disparities
Prostate Testing The American Cancer Society recommends that asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their health care provider about whether to be screened for prostate cancer, after receiving information about the uncertainties, risks, and potential benefits associated with prostate cancer screening.94 This screening should not occur without an informed decisionmaking process. Men at average risk should receive this information at age 50; however, African American and other men at higher risk (men who have a father or brother diagnosed with prostate cancer before age 65) should receive this information beginning at age 45. Men at even higher risk (because they have several close relatives diagnosed with prostate cancer at an early age) should have this discussion with their provider at age 40. The use of the prostate-specific antigen (PSA) blood test to test for prostate cancer is lower in African American males, compared to white males aged 50 and older (38.6% vs. 46.6%, respectively) (Table 7). For more information on prostate cancer testing, see the Special Section of the American Cancer Society Cancer Facts & Figures 2010, available online at cancer.org.
In 2006, the American Cancer Society embarked on an ambitious journey to define its role in the fight against inequities in cancer prevention services, access to care, incidence, and mortality. This effort built on a long history of research and programs designed to understand the causes and effects of cancer disparities, to describe the impact they have on US populations, and to implement and advocate for evidence-based strategies to reduce or eliminate these inequities. The Office of Health Disparities was formed in 2007 to lead the Society’s strategic focus with four overarching goals: 1. Increase trust and credibility of the American Cancer Society among the underserved segment of the population. 2. Ensure effective evidence-based, disparities-reducing practices through the provision of strategic guidance and resources. 3. Enhance and strengthen the Society’s capacity to enable community-based outreach in diverse and low-income communities. 4. Diversify the Society’s volunteer, staff, leadership, and donor base through all levels of the organization. The American Cancer Society continues to work toward the 2015 goal of saving lives and eliminating disparities in cancer morbidity and mortality by helping people stay well and get well, by finding cures, and by fighting back against the disease. This section provides highlights and information on some of these efforts.
Stay Well and Get Well The American Cancer Society helps people everywhere stay well by preventing cancer or detecting it early, when it is most treatable. For people who are diagnosed with cancer, the Society provides the information, day-to-day help, and emotional support to guide them through every step of their experience and to help them get well.
Cancer Information The American Cancer Society provides accurate, up-to-date information spanning the cancer continuum from prevention to palliative care in English and Spanish, 24 hours a day, 7 days a week, via 1-800-227-2345 and through its Web site, cancer.org.
Cancer Facts & Figures for African Americans 2011-2012 19
The Society’s Office of Health Disparities staff is helping in the development of “Welcome to the Fight,” a guide to the American Cancer Society and a cookbook specifically designed for the African American community. The Society has also collaborated with health communications researchers at Morehouse School of Medicine to engage hip-hop artists Mike-E and AfroFlow to promote tobacco and cancer awareness among African American youth on college campuses. World-renowned comedian, actor, and radio personality Steve Harvey partnered with the Society for a video in which he narrated his personal journey of colorectal cancer screening. The video, All Jokes Aside Featuring Steve Harvey, won a Telly Award for best health video, and has been used nationwide to build awareness of the importance of colorectal cancer screening among African American men. The video is available on the American Cancer Society YouTube Channel at tinyurl.com/oh3syq. Other collaborations with the National Medical Association, 100 Black Men of America, Inc., faith-based organizations, and Greek letter fraternities and sororities help the Society achieve its goals of increased cancer screening and awareness in the communities that these partners serve.
Programs and Services Several American Cancer Society programs and services have been developed or tailored to be culturally appropriate for African American audiences. Examples include the following: • Body & Soul – A Celebration of Healthy Eating and Living: This wellness program was developed for African Americans in collaboration with the National Cancer Institute and churches and is currently being supported by the CDC. The program encourages participants to eat 5 to 9 servings of fruits and vegetables every day for better health. Body & Soul works by combining pastoral leadership, educational activities, and peer counseling in a church environment that supports healthy eating. • Let’s Talk About It®: This is a free community-based program developed by the American Cancer Society and 100 Black Men of America, Inc., to increase awareness and knowledge about prostate health among African American men and their loved ones. This program provides communities easy, step-by-step ways to organize prostate cancer awareness events to empower African American men to reduce their risk of prostate cancer and to make informed decisions about detecting and treating the disease. • Patient Navigator Program: This hospital-based service provides a “navigator,” a non-medical professional who can help guide patients through the maze of the health care system – helping patients with a range of tasks, including transportation to appointments, finding ways to pay for care, connecting patients with community support services and other resources, and facilitating communication with physicians and other providers.
Visit cancer.org to learn more about these programs and other support services in your area.
Find Cures Since 1999, the American Cancer Society has funded 117 studies totaling $99 million devoted to the poor and medically underserved. Thirty-five percent of this research focuses on the African American population, encompassing the cancer continuum from prevention to palliative care. The Society is committed to reducing cancer health disparities and has set as a nationwide objective the goal of eliminating disparities in the cancer burden by 2015. Toward this goal, the Society has made the reduction of cancer health disparities a priority area of focus for research funding. In addition, the Society’s internal research departments focus substantial resources on community-based interventions and disparities research. To learn more, visit cancer.org/research. Specific examples of ongoing intramural and extramural research include: • Assessing the specific needs of African American breast cancer survivors through focus groups and surveys and using this information to develop programs and resources to educate and support African American breast cancer survivors • Investigating whether African Americans and whites who are diagnosed with colon cancer make changes in health behaviors (e.g., diet, physical activity, and dietary supplement use) and what effect these changes may have on colorectal recurrence • Researching treatment delays and the types of treatment received among African American breast cancer patients and exploring reasons for the less frequent treatment among African American women in an effort to improve breast cancer outcomes • Monitoring racial and socioeconomic disparities in the cancer burden, including differences in screening, stage at diagnosis, treatment, survival, and mortality • Examining the role of segregated neighborhoods in cancer screening and physical activity among national samples of African Americans and Latinos • Evaluating the usage and effectiveness of smoking cessation help lines in low socioeconomic and segregated African American communities in order for the Society to target and increase use of cessation treatments within these communities • Developing a mapping tool to identify and target underserved populations and assist the Society in more effectively allocating its programs and services
20 Cancer Facts & Figures for African Americans 2011-2012
Fight Back The American Cancer Society and the American Cancer Society Cancer Action Network SM (ACS CAN), the Society’s nonprofit, nonpartisan advocacy affiliate, are dedicated to reducing cancer incidence and mortality rates among minority and medically underserved populations. This goal can be achieved by instituting effective policies and public health programs that promote overall wellness and help save lives. Listed below are some of the efforts at both the state and federal levels that the American Cancer Society and ACS CAN have been involved with in the past few years: Families affected by cancer will face fewer financial barriers to care as a result of the passage of the Patient Protection and Affordable Care Act (Affordable Care Act) in 2010. The law improves the affordability of coverage by increasing insurance subsidies and eliminating arbitrary annual and lifetime caps on coverage for all insurance plans. ACS CAN analyzed the Affordable Care Act through the eyes of cancer patients, survivors, and their families. The analysis showed that the law focuses more on prevention and early detection by requiring all insurance plans to provide coverage for essential, evidence-based preventive measures with no additional co-pays. The law also eliminates discrimination based on health status and preexisting conditions. ACS CAN will continue to look for ways to strengthen the legislation throughout the implementation process. A high priority for the Society and ACS CAN, at both the state and federal level, is fighting to increase funding for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This successful program, which recently celebrated its 20th anniversary, provides community-based breast and cervical cancer screening to low-income, uninsured, and underinsured women. More than 50% of the women screened are from racial/ ethnic minority groups. ACS CAN is asking Congress to increase funding to $275 million for fiscal year 2012. While the Affordable Care Act will greatly improve insurance coverage, the NBCCEDP will remain an essential program for improving access to breast and cervical cancer screening and treatment in our nation’s most vulnerable populations.
The Society and ACS CAN continue to work with Congress to secure additional funding for Patient Navigator Programs, which helps patients in medically underserved communities work their way through the health care system, provides outreach and education for patients to encourage preventive screenings, and addresses needs that may impact compliance with screening and treatment. ACS CAN supports the Affordable Care Act’s reauthorization of the Health Resources and Services Administration Patient Navigator Program until 2015. The Society and ACS CAN also are leading the fight to increase the investment the nation has made in biomedical and cancer research at the National Institutes of Health. These efforts include increased funding for cancer research at the National Center on Minority Health and Health Disparities and the National Cancer Institute, which houses the Center to Reduce Cancer Health Disparities. Additionally, the Society and ACS CAN support the Affordable Care Act’s increased funding for Community Health Centers; required enhanced collection and reporting of data on race, ethnicity, and primary language; and expanded funding for scholarship and loan repayment for physicians working in underserved areas. ACS CAN also advocates for cultural competence and reducing disparities by promoting language translation. In addition, ACS CAN supports the Affordable Care Act’s requirement for qualified health plans to provide materials in appropriate languages, and development of a strategy for increasing access to language translation services. To learn more, to get involved, and to make a difference in the fight against cancer, visit cancer.org/involved/advocate.
The Society and ACS CAN are also advocating for a national screening, treatment, and outreach program to increase colorectal cancer screening rates in low-income, medically underserved populations. The Colorectal Cancer Prevention, Early Detection, and Treatment Act would have a direct impact on reducing colon cancer deaths by focusing on screening more uninsured and underinsured individuals for colorectal cancer and providing them with treatment when needed. ACS CAN strongly supports the Affordable Care Act provision requiring that all private health plans cover colorectal cancer screening tests without any costsharing. By 2011, co-payments will be eliminated for preventive services like colonoscopies, and preventive services will be exempted from deductibles under the Medicare program.
Cancer Facts & Figures for African Americans 2011-2012 21
What Other Programs/ Organizations Support the Elimination of Health Disparities among African Americans? Center to Reduce Cancer Health Disparities (CRCHD) In 2001, the National Cancer Institute (NCI) established the Center to Reduce Cancer Health Disparities (CRCHD) to serve as the cornerstone of NCI’s efforts to reduce the unequal burden of cancer in our nation. CRCHD is working to strengthen and integrate NCI’s studies in basic, clinical, translational, and community-based research that offer opportunities to advance our understanding of cancer-related health disparities and ways to effectively address them. The center manages specific programs and grants aimed at examining the diverse aspects of cancerrelated disparities. It is also leading NCI’s efforts to train students and investigators from diverse populations to pursue research in cancer, as well as research examining factors that contribute to cancer health disparities. For additional information, visit crchd.cancer.gov.
National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Run by the CDC, this program helps low-income, uninsured, and underinsured women gain access to breast and cervical cancer screening and diagnostic services. Medical assistance and treatment for women who are diagnosed with cancer through the NBCCEDP are available through Medicaid. The program is currently implemented in all 50 states, the District of Columbia, 5 US territories, and 12 American Indian/Alaska Native organizations. Each state Department of Health will have information about how to contact the nearest screening center. For additional information, visit cdc.gov/cancer/nbccedp.
Colorectal Cancer Control Program (CRCCP) Thanks in part to many years of advocating for increased funding by ACS CAN volunteers, the CDC in 2009 had sufficient resources to launch a robust colorectal cancer screening program. With $39 million granted to 26 states and tribes nationwide, the CRCCP supports population-based screening efforts and provides early detection tests to low-income adults aged 50 to 64 years who are underinsured or uninsured. For additional information, visit cdc.gov/cancer/crccp.
Project Brotherhood Colorectal Cancer Prevention Funded by the American Cancer Society, Project Brotherhood developed a 12-hour culturally specific curriculum to train barbers about colorectal cancer in order to increase screening rates among African American men. To learn more about this program, visit projectbrotherhood.net.
Deep South Network for Cancer Control The purpose of the Deep South Network for Cancer Control is to eliminate the disparity in cancer death rates between African Americans and whites in the Deep South. This initiative has increased mammography screening in Mississippi and Alabama and is working toward reducing racial disparities in breast and cervical cancer mortality by encouraging coalition development, community empowerment, and the utilization of community health advisors. To learn more about this program, visit mhrc.dopm.uab.edu/research/deepsouth.
Cancer Prevention and Control Research Network (CPCRN) The CPCRN is a subgroup of the CDC’s Prevention Research Centers and is currently comprised of 10 funded academic research institutions. The network provides an infrastructure for applying relevant research to local cancer prevention and control needs, particularly in underserved and minority communities. Its members conduct community-based participatory cancer research across its 10 network centers, crossing academic affiliations and geographic boundaries. For additional information, visit cpcrn.org.
Intercultural Cancer Council (ICC) The ICC promotes policies, programs, partnerships, and research to eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations in the US and its associated territories. For additional information, visit iccnetwork.org.
National Medical Association (NMA) The NMA is the largest and oldest national organization representing African American physicians and their patients in the US and is committed to the elimination of health disparities and the promotion of healthy lifestyles among African Americans and other underserved populations. The American Cancer Society and the NMA have joined together to develop and distribute culturally relevant consumer and professional materials that focus on the prevention, early detection, and treatment of breast, prostate, and colorectal cancers, as well as nutrition and physical activity. For additional information, visit nmanet.org.
22 Cancer Facts & Figures for African Americans 2011-2012
National African American Tobacco Education Network (NAATEN) NAATEN is a collaboration of national, state, and communitybased organizations serving the African American community. The network’s goal is to eliminate tobacco use in the African American community by serving as a leader and unified voice on a national level and by engaging African American organizations in the prevention and reduction of tobacco use. For additional information, visit healthedcouncil.org/naaten.
African American Collaborative Obesity Research Network (AACORN) AACORN is a collaboration of US researchers, scholars-in-training, and community-based research partners dedicated to improving the quality and quantity of research to address weight-related health issues in African American communities. For additional information, visit aacorn.org.
Cancer Facts & Figures for African Americans 2011-2012 23
Sources of Statistics New Cancer Cases. The estimated numbers of new US cancer cases among African Americans in 2011 were calculated by fitting the estimated numbers of cancer cases that occurred each year in the US from 1995 through 2007 to a statistical forecasting model. The estimated numbers of US cases from 1995 through 2007 were calculated using incidence data for these years from 44 states that met the North American Association of Central Cancer Registries’ (NAACCR) high-quality data standard for incidence and population data collected by the US Census Bureau. Incidence Rates. Incidence rates are defined as the number of people per 100,000 who are diagnosed with a disease during a given period of time. Incidence data for this publication were collected either by the Surveillance, Epidemiology, and End Results (SEER) program or the National Program of Cancer Registries as reported by NAACCR, as stated.95 Where noted, incidence rates adjusted for reporting delay are used. All incidence rates in this publication are age adjusted to the 2000 US standard population.
Probability of Developing or Dying of Cancer. Probabilities of developing or dying of cancer were calculated using DevCan 6.5.0, developed by the National Cancer Institute.97 These probabilities reflect the average experience of people in the US and do not take into account individual behaviors and risk factors. For example, the estimate of 1 African American man in 13 developing lung cancer in a lifetime underestimates the risk for smokers and overestimates the risk for nonsmokers. National Health Interview Survey (NHIS). The NHIS is a survey of the NCHS. The survey is designed to provide national prevalence estimates on personal, socioeconomic, demographic, and health characteristics, such as cigarette smoking and physical activity. Data are gathered through a computer-assisted personal interview of adults aged 18 and older. The NHIS is an annual survey that has been conducted by NCHS since 1957. For more information, visit cdc.gov/nchs/nhis.htm.
Cancer Deaths. The estimated number of US cancer deaths among African Americans in 2011 is calculated by fitting the numbers of cancer deaths from 1969 through 2007 to a statistical forecasting model. Data on the number of deaths are obtained from the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC). Mortality Rates. Mortality rates or death rates are defined as the number of people per 100,000 who die from a disease during a given year. Death rates were reported by the SEER program using data on cancer deaths from the National Center for Health Statistics along with population data from the US Census Bureau.96 All death rates in this publication were age adjusted to the 2000 US standard population. Survival. Five-year relative survival rates are presented in this report for cancer patients diagnosed between 1999-2006 and followed through 2007. Relative survival rates are used to adjust for normal life expectancy (and events such as death from heart disease, accidents, and diseases of old age). These rates are calculated by dividing observed 5-year survival rates for cancer patients by observed 5-year survival rates for people in the general population who are similar to the patient group with respect to age, gender, race, and calendar year of observation. Five-year survival statistics presented in this publication were originally published in the SEER Cancer Statistics Review, 1975-2007.4
24 Cancer Facts & Figures for African Americans 2011-2012
Screening Guidelines for the Early Detection of Cancer in Average-risk Asymptomatic People Cancer Site Population
Test or Procedure
Frequency
Breast
Breast self-examination
Beginning in their early 20s, women should be told about the benefits and limitations of breast self-examination (BSE). The importance of prompt reporting of any new breast symptoms to a health professional should be emphasized. Women who choose to do BSE should receive instruction and have their technique reviewed on the occasion of a periodic health examination. It is acceptable for women to choose not to do BSE or to do BSE irregularly.
Clinical breast examination
For women in their 20s and 30s, it is recommended that clinical breast examination (CBE) be part of a periodic health examination, preferably at least every three years. Asymptomatic women aged 40 and over should continue to receive a clinical breast examination as part of a periodic health examination, preferably annually.
Mammography
Begin annual mammography at age 40.*
Tests that find polyps and cancer: Flexible sigmoidoscopy,§ or
Every five years, starting at age 50
Colonoscopy, or
Every 10 years, starting at age 50
Double-contrast barium enema (DCBE),§ or
Every five years, starting at age 50
CT colonography (virtual colonoscopy)§
Every five years, starting at age 50
Colorectal†
Women, age 20+
Men and women, age 50+
Tests that mainly find Annual, starting at age 50 cancer: Fecal occult blood test (FOBT) with at least 50% test sensitivity for cancer, or fecal immunochemical test (FIT) with at least 50% test sensitivity for cancer§,‡ or Stool DNA test (sDNA)§
Interval uncertain, starting at age 50
Prostate
Men, age 50+
Prostate-specific antigen test (PSA) with or without digital rectal exam (DRE).
Asymptomatic men who have at least a 10-year life expectancy should have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after receiving information about the uncertainties, risks, and potential benefits associated with screening. Men at average risk should receive this information beginning at age 50. Men at higher risk, including African American men and men with a first degree relative (father or brother) diagnosed with prostate cancer before age 65, should receive this information beginning at age 45. Men at appreciably higher risk (multiple family members diagnosed with prostate cancer before age 65) should receive this information beginning at age 40.
Cervix
Women, age 18+
Pap test
Cervical cancer screening should begin approximately three years after a woman begins having vaginal intercourse, but no later than 21 years of age. Screening should be done every year with conventional Pap tests or every two years using liquid-based Pap tests. At or after age 30, women who have had three normal test results in a row may get screened every two to three years with cervical cytology (either conventional or liquid-based Pap test) alone, or every three years with an HPV DNA test plus cervical cytology. Women 70 years of age and older who have had three or more normal Pap tests and no abnormal Pap tests in the past 10 years and women who have had a total hysterectomy may choose to stop cervical cancer screening.
Endometrial Women, at menopause
At the time of menopause, women at average risk should be informed about risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physicians.
Cancerrelated checkup
On the occasion of a periodic health examination, the cancer-related checkup should include examination for cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures.
Men and women, age 20+
*Beginning at age 40, annual clinical breast examination should be performed prior to mammography. † Individuals with a personal or family history of colorectal cancer or adenomas, inflammatory bowel disease, or high-risk genetic syndromes should continue to follow the most recent recommendations for individuals at increased or high risk. ‡ For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. A FOBT or FIT done during a digital rectal exam in the doctor’s office is not adequate for screening. § Colonoscopy should be done if test results are positive. ¶ Information should be provided to men about the benefits and limitations of testing so that an informed decision about testing can be made with the clinician’s assistance.
Cancer Facts & Figures for African Americans 2011-2012 25
References
19. Taplin SH, Ichikawa L, Yood MU, et al. Reason for late-stage breast cancer: absence of screening or detection, or breakdown in follow-up? J Natl Cancer Inst. Oct 20 2004;96(20):1518-1527.
1. US Census Bureau. U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin: 2000-2050, Detailed data files. http://www.census.gov/ ipc/www/usinterimproj/. Accessed July 8, 2010.
20. Hahn KM, Bondy ML, Selvan M, et al. Factors associated with advanced disease stage at diagnosis in a population-based study of patients with newly diagnosed breast cancer. Am J Epidemiol. Nov 1 2007;166(9):1035-1044.
2. US Census Bureau. Table B02009: BLACK OR AFRICAN AMERICAN ALONE OR IN COMBINATION WITH ONE OR MORE OTHER RACES. 2008 American Community Survey 1-Year Estimates. factfinder.census. gov. Accessed September 23, 2010.
21. Smith-Bindman R, Miglioretti DL, Lurie N, et al. Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med. Apr 18 2006;144(8):541-553.
3. Arias E. United States life tables, 2006. Natl Vital Stat Rep. June 28 2010;58(21):1-40. 4. Altekruse SF, Kosary CL, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975-2007. Bethesda, MD: National Cancer Institute; 2010. 5. Delancey JOL, Thun MJ, Jemal A, Ward E. Recent trends in BlackWhite disparities in cancer mortality. Cancer Epidemiol Biomarkers Prev. 2008;17(11):1-5. 6. Jemal A, Center MM, Ward E. The convergence of lung cancer rates between blacks and whites under the age of 40, United States. Cancer Epidemiol Biomarkers Prev. Dec 2009;18(12):3349-3352. 7. Ward E, Halpern M, Schrag N, et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. Jan-Feb 2008;58(1):9-31. 8. Bach PB, Schrag D, Brawley OW, Galaznik A, Yakren S, Begg CB. Survival of blacks and whites after a cancer diagnosis. JAMA. Apr 24 2002;287(16):2106-2113. 9. Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst. Mar 6 2002;94(5):334-357. 10. Smedley BD, Stith AY, Nelson AR, eds. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press; 2002. 11. Jemal A, Clegg LX, Ward E, et al. Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer. Jul 1 2004;101(1):3-27. 12. Carey LA, Perou CM, Livasy CA, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. Jun 7 2006;295(21):2492-2502. 13. Li CI, Malone KE, Daling JR. Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older. Cancer Epidemiol Biomarkers Prev. Jul 2002;11(7):601-607. 14. Chlebowski RT, Chen Z, Anderson GL, et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst. Mar 16 2005;97(6):439-448. 15. Irvin WJ, Jr., Carey LA. What is triple-negative breast cancer? Eur J Cancer. Dec 2008;44(18):2799-2805. 16. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. Oct 27 2005;353(17):1784-1792. 17. Menashe I, Anderson WF, Jatoi I, Rosenberg PS. Underlying causes of the black-white racial disparity in breast cancer mortality: a population-based analysis. J Natl Cancer Inst. Jul 15 2009;101(14):993-1000. 18. Komenaka IK, Martinez ME, Pennington RE, Jr., et al. Race and ethnicity and breast cancer outcomes in an underinsured population. J Natl Cancer Inst. Aug 4 2010;102(15):1178-1187.
22. Lund MJ, Brawley OP, Ward KC, Young JL, Gabram SS, Eley JW. Parity and disparity in first course treatment of invasive breast cancer. Breast Cancer Res Treat. Jun 2008;109(3):545-557. 23. Edwards BK, Brown ML, Wingo PA, et al. Annual report to the nation on the status of cancer, 1975-2002, featuring population-based trends in cancer treatment. J Natl Cancer Inst. Oct 5 2005;97(19):1407-1427. 24. Smith GL, Shih YC, Xu Y, et al. Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study. Cancer. Feb 1 2010;116(3):734-741. 25. Elledge RM, Clark GM, Chamness GC, Osborne CK. Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States. J Natl Cancer Inst. May 4 1994;86(9):705-712. 26. Setiawan VW, Monroe KR, Wilkens LR, Kolonel LN, Pike MC, Henderson BE. Breast cancer risk factors defined by estrogen and progesterone receptor status: the multiethnic cohort study. Am J Epidemiol. May 15 2009;169(10):1251-1259. 27. Gordon NH. Socioeconomic factors and breast cancer in black and white Americans. Cancer Metastasis Rev. Mar 2003;22(1):55-65. 28. Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst. Apr 3 2002;94(7):490-496. 29. Thomson CS, Hole DJ, Twelves CJ, Brewster DH, Black RJ. Prognostic factors in women with breast cancer: distribution by socioeconomic status and effect on differences in survival. J Epidemiol Community Health. May 2001;55(5):308-315. 30. Saslow D, Castle PE, Cox JT, et al. American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin. Jan-Feb 2007;57(1):7-28. 31. Wang SS, Sherman ME, Hildesheim A, Lacey JV, Jr., Devesa S. Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for 19762000. Cancer. Mar 1 2004;100(5):1035-1044. 32. Mandelblatt J, Andrews H, Kerner J, Zauber A, Burnett W. Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class, and hospital type. Am J Public Health. May 1991;81(5):646-649. 33. Cardin VA, Grimes RM, Jiang ZD, Pomeroy N, Harrell L, Cano P. Low-income minority women at risk for cervical cancer: a process to improve adherence to follow-up recommendations. Public Health Rep. Nov-Dec 2001;116(6):608-616. 34. Wolin KY, Yan Y, Colditz GA, Lee IM. Physical activity and colon cancer prevention: a meta-analysis. Br J Cancer. Feb 24 2009;100(4):611616. 35. Howard RA, Freedman DM, Park Y, Hollenbeck A, Schatzkin A, Leitzmann MF. Physical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study. Cancer Causes Control. Nov 2008;19(9):939-953.
26 Cancer Facts & Figures for African Americans 2011-2012
36. Samad AK, Taylor RS, Marshall T, Chapman MA. A meta-analysis of the association of physical activity with reduced risk of colorectal cancer. Colorectal Dis. May 2005;7(3):204-213.
54. Potosky AL, Feuer EJ, Levin DL. Impact of screening on incidence and mortality of prostate cancer in the United States. Epidemiol Rev. 2001;23(1):181-186.
37. Secretan B, Straif K, Baan R, et al. A review of human carcinogens– Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol. Nov 2009;10(11):1033-1034.
55. Hsing AW, Devesa SS. Trends and patterns of prostate cancer: what do they suggest? Epidemiol Rev. 2001;23(1):3-13.
38. Polite BN, Dignam JJ, Olopade OI. Colorectal cancer model of health disparities: understanding mortality differences in minority populations. J Clin Oncol. May 10 2006;24(14):2179-2187. 39. Laiyemo AO, Doubeni C, Pinsky PF, et al. Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities. J Natl Cancer Inst. Apr 21 2010;102(8):538-546. 40. Potosky AL, Harlan LC, Kaplan RS, Johnson KA, Lynch CF. Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer. J Clin Oncol. Mar 1 2002;20(5):1192-1202.
56. Andriole GL, Crawford ED, Grubb RL, 3rd, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. Mar 26 2009;360(13):1310-1319. 57. Hugosson J, Carlsson S, Aus G, et al. Mortality results from the Goteborg randomised population-based prostate-cancer screening trial. Lancet Oncol. Aug 2010;11(8):725-732. 58. Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostatecancer mortality in a randomized European study. N Engl J Med. Mar 26 2009;360(13):1320-1328.
41. Dimou A, Syrigos KN, Saif MW. Disparities in colorectal cancer in African-Americans vs Whites: before and after diagnosis. World J Gastroenterol. Aug 14 2009;15(30):3734-3743.
59. DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, Current Population Reports, P60-236, Income, Poverty, and Health Insurance Coverage in the United States: 2008. Washington, DC: U.S. Government Printing Office; 2009.
42. White A, Liu CC, Xia R, et al. Racial disparities and treatment trends in a large cohort of elderly African Americans and Caucasians with colorectal cancer, 1991 to 2002. Cancer. Dec 15 2008;113(12):3400-3409.
60. Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ ethnicity and socioeconomic status. CA Cancer J Clin. Mar-Apr 2004;54(2):78-93.
43. United States Department of Health and Human Services. Tobacco use among US racial/ethnic minority groups – African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: a report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health;1998.
61. Kinsey T, Jemal A, Liff J, Ward E, Thun M. Secular trends in mortality from common cancers in the United States by educational attainment, 1993-2001. J Natl Cancer Inst. Jul 16 2008;100(14):1003-1012.
44. Anderson C, Burns DM. Patterns of adolescent smoking initiation rates by ethnicity and sex. Tob Control. 2000;9 Suppl 2:II4-8. 45. Mulligan CR, Meram AD, Proctor CD, Wu H, Zhu K, Marrogi AJ. Unlimited access to care: effect on racial disparity and prognostic factors in lung cancer. Cancer Epidemiol Biomarkers Prev. Jan 2006;15(1):2531. 46. Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev. Aug 2010;19(8):1893-1907. 47. Brawley OW, Berger MZ. Cancer and disparities in health: perspectives on health statistics and research questions. Cancer. Oct 1 2008;113(7 Suppl):1744-1754. 48. Albano JD, Ward E, Jemal A, et al. Cancer mortality in the United States by education level and race. J Natl Cancer Inst. Sep 19 2007;99(18):1384-1394. 49. Brawley OW, Ankerst DP, Thompson IM. Screening for prostate cancer. CA Cancer J Clin. Jul-Aug 2009;59(4):264-273. 50. Etzioni R, Gulati R, Falcon S, Penson DF. Impact of PSA screening on the incidence of advanced stage prostate cancer in the United States: a surveillance modeling approach. Med Decis Making. May-Jun 2008;28(3):323-331. 51. Chu KC, Tarone RE, Freeman HP. Trends in prostate cancer mortality among black men and white men in the United States. Cancer. Mar 15 2003;97(6):1507-1516. 52. Cooperberg MR, Grossfeld GD, Lubeck DP, Carroll PR. National practice patterns and time trends in androgen ablation for localized prostate cancer. J Natl Cancer Inst. Jul 2 2003;95(13):981-989. 53. Hankey BF, Feuer EJ, Clegg LX, et al. Cancer surveillance series: interpreting trends in prostate cancer--part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst. Jun 16 1999;91(12):1017-1024.
62. Doll R, Peto R. The Causes of Cancer. New York: Oxford University Press; 1981. 63. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic Costs-United States, 1995-1999: Centers for Disease Control and Prevention;2002. 51(14): 300-303. 64. US Department of Health and Human Services. The Health Consequences of Smoking – A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health;2004. 65. Cigarette use among high school students - United States, 19912009. MMWR Morb Mortal Wkly Rep. Jul 9 2010;59(26):797-801. 66. International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention. Volume 6: Weight Control and Physical Activity. Lyon, France: IARC Press; 2002. 67. Calle EE, Thun MJ. Obesity and cancer. Oncogene. Aug 23 2004;23(38):6365-6378. 68. World Cancer Research Fund / American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR;2007. 69. Benjamin M, Reddy S, Brawley OW. Myeloma and race: a review of the literature. Cancer Metastasis Rev. Mar 2003;22(1):87-93. 70. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ. Dec 1 2007;335(7630):1134. 71. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. Feb 16 2008;371(9612):569-578. 72. Wei EK, Wolin KY, Colditz GA. Time course of risk factors in cancer etiology and progression. J Clin Oncol. Sep 10 2010;28(26):4052-4057. 73. Sarker M, Jatoi I, Becher H. Racial differences in breast cancer survival in women under age 60. Breast Cancer Res Treat. Nov 2007;106(1):135-141.
Cancer Facts & Figures for African Americans 2011-2012 27
74. McWilliams RR, Matsumoto ME, Burch PA, et al. Obesity adversely affects survival in pancreatic cancer patients. Cancer. Jul 21 2010. 75. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. Jan 20 2010;303(3):242-249. 76. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. Jan 20 2010;303(3):235241. 77. Kushi LH, Byers T, Doyle C, et al. American Cancer Society Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. Sep-Oct 2006;56(5):254-281; quiz 313-254. 78. Larsson SC, Wolk A. Meat consumption and risk of colorectal cancer: a meta-analysis of prospective studies. Int J Cancer. Dec 1 2006;119(11):2657-2664. 79. Chao A, Thun MJ, Connell CJ, et al. Meat consumption and risk of colorectal cancer. JAMA. Jan 12 2005;293(2):172-182. 80. Zheng W, Lee SA. Well-done meat intake, heterocyclic amine exposure, and cancer risk. Nutr Cancer. 2009;61(4):437-446. 81. Patel AV, Callel EE, Bernstein L, Wu AH, Thun MJ. Recreational physical activity and risk of postmenopausal breast cancer in a large cohort of US women. Cancer Causes Control. Aug 2003;14(6):519-529. 82. Pleis JR, Lucas JW, Ward BW. Summary health statistics for US adults: National Health Interview Survey, 2008. Vital Health Stat. 2009;10(242). 83. Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Quarterly. 2009;87(1):123-154. 84. Lovasi GS, Hutson MA, Guerra M, Neckerman KM. Built environments and obesity in disadvantaged populations. Epidemiol Rev. 2009;31:7-20. 85. Koplan J, Liverman C, Kraak V, eds. Preventing Childhood Obesity: Health in the Balance. Washington, DC: Institute of Medicine; 2005. 86. Department of Health and Human Services. The Surgeon General’s call to action to prevent and decrease overweight and obesity. Washington, DC: US Department of Health and Human Services;2001. 87. Powell LM, Chaloupka FJ, Slater SJ, Johnston LD, O’Malley PM. The availability of local-area commercial physical activity-related facilities and physical activity among adolescents. Am J Prev Med. 2007 33(4 Suppl):S292-300.
88. Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. Mar-Apr 2010;60(2):99-119. 89. Cancer Trends Progress Report – 2009/2010 Update. National Cancer Institute, NIH, DHHS, Bethesda, MD; April 2010, http://progressreport. cancer.gov. 90. Jones BA, Dailey A, Calvocoressi L, et al. Inadequate follow-up of abnormal screening mammograms: findings from the race differences in screening mammography process study (United States). Cancer Causes Control. Sep 2005;16(7):809-821. 91. American Cancer Society. Cancer Prevention and Early Detection Facts and Figures. Atlanta, GA: American Cancer Society; 2010. 92. Tangka FK, Dalaker J, Chattopadhyay SK, et al. Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002-2003 (United States). Cancer Causes Control. Nov 2006;17(9):11451154. 93. Breen N, Wagener DK, Brown ML, Davis WW, Ballard-Barbash R. Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst. Nov 21 2001;93(22):1704-1713. 94. Wolf AM, Wender RC, Etzioni RB, et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin. Mar-Apr 2010;60(2):70-98. 95. Surveillance, Epidemiology and End Results (SEER) Program (www. seer.cancer.gov) SEER*Stat Database: NAACCR Incidence – CiNA Analytic File, 1995-2007, North American Association of Central Cancer Registries. 96. Surveillance, Epidemiology, and End Results (SEER) Program (www. seer.cancer.gov) SEER*Stat Database: Mortality - All COD, Aggregated With State, Total U.S. (1969-2007) , National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released June 2010. Underlying mortality data provided by NCHS (www.cdc.gov/nchs). 97. DevCan: Probability of Developing or Dying of Cancer Software, Version 6.5.0; Statistical Research and Applications Branch, National Cancer Institute, 2005. http://srab.cancer.gov/devcan.
28 Cancer Facts & Figures for African Americans 2011-2012
Chartered Divisions of the American Cancer Society, Inc. California Division, Inc. 1710 Webster Street Oakland, CA 94612 (510) 893-7900 (O) (510) 835-8656 (F) East Central Division, Inc. (PA, OH) Route 422 and Sipe Avenue Hershey, PA 17033-0897 (717) 533-6144 (O) (717) 534-1075 (F) Eastern Division, Inc. (NJ, NY) 6725 Lyons Street East Syracuse, NY 13057 (315) 437-7025 (O) (315) 437-0540 (F) Florida Division, Inc. (including Puerto Rico operations) 3709 West Jetton Avenue Tampa, FL 33629-5146 (813) 253-0541 (O) (813) 254-5857 (F) Puerto Rico Calle Alverio #577 Esquina Sargento Medina Hato Rey, PR 00918 (787) 764-2295 (O) (787) 764-0553 (F)
Great Lakes Division, Inc. (IN, MI) 1755 Abbey Road East Lansing, MI 48823-1907 (517) 332-2222 (O) (517) 664-1498 (F) Great West Division, Inc. (AK, AZ, CO, ID, MT, ND, NM, NV, OR, UT, WA, WY) 2120 First Avenue North Seattle, WA 98109-1140 (206) 283-1152 (O) (206) 285-3469 (F) High Plains Division, Inc. (including Hawaii operations, KS, MO, NE, OK, TX) 2433 Ridgepoint Drive Austin, TX 78754 (512) 919-1800 (O) (512) 919-1844 (F) Hawaii Pacific Division, Inc. 2370 Nuuana Avenue Honolulu, HI (808) 595-7500 (O) (808) 595-7502 (F) Illinois Division, Inc. 225 N. Michigan Avenue Suite 1200 Chicago, IL 60601 (312) 641-6150 (O) (312) 641-3533 (F)
Mid-South Division, Inc. (AL, AR, KY, LA, MS, TN) 1100 Ireland Way Suite 300 Birmingham, AL 35205-7014 (205) 930-8860 (O) (205) 930-8877 (F) Midwest Division, Inc. (IA, MN, SD, WI) 8364 Hickman Road Suite D Des Moines, IA 50325 (515) 253-0147 (O) (515) 253-0806 (F) New England Division, Inc. (CT, ME, MA, NH, RI, VT) 30 Speen Street Framingham, MA 01701-9376 (508) 270-4600 (O) (508) 270-4699 (F) South Atlantic Division, Inc. (DE, GA, MD, NC, SC, VA, Washington, D.C., WV) 250 Williams Street Atlanta, GA 30303 (404) 816-7800 (O) (404) 816-9443 (F)
©2011, American Cancer Society, Inc. No.861411 Models used for illustrative purposes only.
